Objective To retrospectively describe the technique and review the surgical results of OsteoMed M3 titanium plate and screws used to secure the posterior elements in the open position after expansive unilateral opendoor laminoplasty.Methods Twenty-six patients with multilevel cervical disc herniation and canal stenosis were treated with an expansive unilateral open-door laminoplasty with OsteoMed M3 plate and screws.The follow-up period was over 1 year.The improvement of spinal function after surgeries under JOA was evaluated to analyse the effects and releated factors.Results All of 26 cases' follow-up period was over 1 year.The mean JOA score increased significantly from 9.40 ± 1.658 ( range,5 to 13 ) points before surgery to 13.80 ± 1.958 ( range,7 to 16) points at final follow- up ( t =- 21.137,P =0.000 ).Mean recovery rate was 57.9％.Postoperative radiography,magnetic resonance imaging and computed tomography scan demonstrated significantly increased sagittal diameter and canal expansion.Two cases without relief of nurological symptoms underwent an additional anterior multilevel corpectomy.One case with ossification of the posterior longitudinal ligament had not good enough neurologic improvement after surgery.No neurologic deterioration owing to hinge reclosure or major surgery-related complications were observed.It would reduce the recovery for those with old age,long history,worse symptoms,cervical kyphosis and abnormal signal in MR imaging.It was good for patients to do early active cervical exercises after surgery.Conclusion Unilateral open- door laminoplasty with OsteoMed M3 titanium plate and screws fixation effectively maintains expansion of the spinal canal and resists closure while preserving alignment and stability.This modified technique is easy to perform with a low complication,is and economic,and is good for clinical application.

Objective To evaluate the clinical significance of low ligation and high ligation of inferior mesenteric artery (IMA) and lymph nodes dissection on radical resection for rectal cancer.Methods One hundred and fifty-six patients who were diagnosed rectal cancer in our hospital between May 2007 and May 2008 were divided into low ligation group (80 cases)and high ligation group (76 cases).The low ligation group was treated with low ligation of IMA and lymph nodes dissection,the high ligation group was cured by high ligation of IMA and lymph nodes dissection.cases.The IMA lymph nodes metastasis,number of lymph nodes,cancer recurernce rate,5-year survival rate,complication rate were compared and analyzed.Results The rate of lymph nodes metastasis around the origin of inferior mesenteric artery was 15.0％ in the low ligation group,the rate of lymph nodes metastasis around the origin of inferior mesenteric artery was 14.5％ in the high ligation group,and the difference was not statistically significant (P ＞ 0.05).Compared two groups of postoperative recurrence rate,5-year survival rate,anastomotic leakage rate,sexual dysfunction rate and urinary retention rate,there was no significant differences (P ＞ 0.05).The intestinal function recovery time and low anterior resection syndrome incidence of the low ligation group were lower than the high ligation group,there were significant differences (P ＜ 0.05).Conclusions Low ligation of inferior mesenteric artery and lymph nodes dissection can achieve radical resection for rectal cancer.Compared with traditional high ligation of inferior mesenteric artery,there were no differences for patients on recurrence rate,5-year survival rate and complication rate.

Objective To study the clinical value of anatomizing and ligating the short hepatic veins (SHVs) and right hepatic veins through the right Retrohepatic Tunnel (RT) in right hemibepatectomy of giant hepatic carcinoma.Methods We performed the right hemibepatectomy on 23 patients with huge tumors which diameters were lager than 8 cm.There were four main procedures during the operation.Firstly,sperated the interspace between right hepatic veins and middle hepatic veins through secundum porta hepatis.Secondly,seperated and ligated the right hepatic portal vein and hepatic artery in the Glisson's system.Thirdly,anatomized and ligated SHVs and right hepatic veins through the right RT conversly.Finally,set a blocking-belt at the left of the central liver and then cut the right hemi-hepar.Results The anatomy of right hepatic artery,Portal Vein,retrohepatic inferior vena cava (RHIVC),right hepatic veins was well done.The intraoperative blood loss of 7 patients was less than 400 mL,and 11 was 500-700 mL,2 was 800-1 000 mL,3 was 1 100-1 400 mL,and average was 640 mL.The hepatic function was changed in the third day afteroperation.The numerus of TBIL of 16 patients was 20-40 μmol/L,and 6 was 45-50 μmol/L,and 1 was 60 μmol/L.The numerus of ALT of 14 patients was 150-200 U/L,and 9 was 250-400 U/L.The numerus of AST of of 13 patients was 160-200 U/L,and 9 was 230-400 U/L,and 1 was 430 U/L.The numerus of GGT of 14 patients was 160-200 U/L,and 8 was 220-310 U/L,and 1 was 420 U/L.The hepaticfailure happened to 1 patient because of deep venous infection.Conclusions The right hemibepatectomy through the right retrohepatic tunnel is feasible in the tumor without invasion the RHIVC and diaphragm,or the volume was not too huge.The operation could reduce the blood loss and make for the recovery of hepatic funtions.

Objective To explore the influence of brief ischemic on fracture healing.Methods Two hundred and forty wistar rats (weight was 200 g and half male) were made the right tibial midpiece closed fracture model.1.0 mm K-wires were used to fix the fractures.Rats were divided into 4 groups.Group A was 24 hours,group B was 48 hours,group C was 72 hours,and group D was the control group.Tourniquet was used on the root of the thigh of right lower limb.Tourniquet was inflated 10 min,then released 10 min,and repeated 3 times to make the brief ischemic model.48 rats were made brief ischemic at 24 hours after the fracture fixed.Then group A was at every 24 hours,group B was at every 48 hours,and group C was at every 72 hours made brief ischemic.Group D at every 24 hours after the fracture fixed was used tourniquet on the root of thigh of right lower limb each time 1 hour,but the tourniquet was not inflated.Group A,B,and C were made brief ischemic 5 weeks.Group D was tourniquet treated 5 weeks.Group A and D at 1 day,3 days,5 days,and 7 days after fracture fixed were detected the serum VEGF.All groups of rats were X-ray examinated and detected of serum VEGF at every two weeks after the fracture fixed.Every two weeks,every group randomly selected 12 rats to do immunohistochemical staining.We used the Image Pro Plus software to quantitative compare the IGF-2 positive cells in the fracture area.Results X-ray results were used three points method for analyzing.The scores of group A,B,and C were significantly higher than group D at 2 weeks,4 weeks,6 weeks after fracture fixed (P ＜ 0.05).The scores between group A,B,and C were no significant statistical difference at 2 weeks,4 weeks,6 weeks after fracture fixed (P ＞ 0.05).The levels of serum VEGF of group A were significantly higher than group D at 3days,5days,and 7 days after fracture fixed (P ＜ 0.05).The levels of serum VEGF of group B and C were obviously higher than group A and D at 2 weeks (P ＜ 0.05),and there was no obvious difference between group B and C (P =0.79,P =0.90,P =0.88).The same result was found between group A and D (P =0.94,P =0.551,P =0.53).There were no significant difference between four groups on the levels of serum VEGF at 8 weeks (P =0.66).Immunohistochemical results were that group B,group C VEGF positive cells were significantly higher than group A and group D at 2 weeks,4 weeks,6 weeks (P ＜0.05).There was no significant difference in group B and group C (P =0.19,P =0.10,P =0.38),or group A and group D (P =0.07,P =0.17,P =0.18).There was no significantly different in four groups at 8 weeks (P =0.08).Conclusions Brief ischemic can promote the healing of fracture and stimulate the expression of VEGF.The mechanism may be related to the signal channels of VEGF and other biological factors.This study will give new idea to clinic for promoting fracture healing.

Objective To explore the application value of Carbon Nanoparticles followed by microscale Methylthioninum Chloride in sentinel lymph node biopsy for breast cancer.Methods Two hundred and eight breast cancer patients were selected in the First Affiliated Hospital of Zhengzhou University during recent two years who performed sentinel lymph node biopsy.They were randomly divided into five groups according to different lymphatic tracer injected:Sequential group (A group,128 patients),Carbon Nanoparticles group (B group,44 patients) and Methylthioninum Chloride group (C group,36 patients).According to different Methylthioninum Chloride doses,sequential groups were randomly divided into low dose group (A1 group,48 patients),middle dose group (A2 group,42 patients),high dose group (A3 group,38 patients),If sentinel lymph nodes were negative no longer performed axillary lymph nodes dissection.Receive the five groups statistics of detection rate,the condition of lymphatic tracer,the incidence of local skin irritation and so on.Results (1) The detection rate of A,B and C three groups had no obvious difference.The incidence of lymphatic tracer dyed not ideal in B group was higher than A and B two groups,the incidence of local skin stimulation in C group was higher than A and B two groups.(2) A1,A2,A3,three groups had no difference of the detection rate and lymphatic tracer,but the incidence of local skin stimulation in A3 group is higher than A1,A2 two groups.3.5 groups of SLN detection rate had no relationship with patients' age,BMI,tumor size,tumor location,tumor molecular classification factors (P ＞ 0.05).Conclusions Carbon Nanoparticles followed by microscale Methyhhioninum Chloride detection rate was similar with two separate application,but can reduce the lymphatic vessels not developing situation when used Carbon Nanoparticles alone and reduce the local irritation caused by large dose of Methylthioninum Chloride,so it can be a good choice of SLNB in clinical.

Objective To assess the accuracy of histological type and molecular subtype observed in preoperative 11-gauge vacuum-assisted core needle biopsy(VACNB) specimens in breast cancer.Methods Patients diagnosed by preoperative 1 l-gauge VACNB and received subsequent open excisional biopsy (OEB) from Mar 1 st 2014 to Mar 31 st 2015 were included.Kappa testing was used to test the concordance rate of histological type,estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor 2(Her-2),Ki-67 and molecular subgroups between VACNB and paired OEB specimens.ER,PgR,Her-2,and Ki-67 were determined by immunohistochemistry (IHC).Patients with Her-2 IHC (+ +) were further examined by FISH.Molecular subtypes were classified as follows:LuminalA,LuminalB,Triple Negative,and Her-2 positive.Results There were 36 patients analyzed(32 of them had invasive breast cancer).Between VACNB and paired OEB specimens,concordance rate of histological type,ER,PR,Her-2,Ki-67 and molecular group were 94.4％ (κ =0.934),96.9％ (κ =0.904),87.5％ (κ =0.710),100％ (κ =1.000),84.4％ (κ =0.570),78.1％ (κ =0.621).No significant difference was detected in the expression of ER,PR and Ki-67 between VACNB and OEB specimens according to paired t-test results.Concordance rate of each molecular subtype between VACNB and OEB specimens were 100％ for Her-2 positive subtype,94.1％ for LuminalB subtype,50％ for LuminalA,and 33.3％ for TNBC.When the threshold for ER/PR positivity was upgraded from ≥1％ to ≥10％ and Ki-67 cutoff value to≥20％,the concordance rate for ER,PR,Ki-67 and molecular subtype reached to 100％,93.8％,87.5％,81.3％.Conclusions 11 G vacuum-assisted core needle biopsy was accurate in determining histological type and molecular subtype in breast cancer.

Fine needle aspiration cytopathology of the breast is an effective means of distinguishing malignant from benign,and the aspirated sample collections techniques is the primary and key part of fine needle aspiration.Fine needle aspiration cell block has been improved and used on preoperative breast cancer molecular portraits.This paper will provide an introduction to application of specimens collection techniques,application and development of fine needle aspiration cell block on preoperative breast cancer molecular portraits.

Objeetive To investigate the effect of TURP on the quality of life of elderly PCa patients with LUTS symptoms.Methods A retrospective analysis of the clinical data from January 2012 to January 2014 of 75 patients admitted to our hospital after prostate puncture biopsy and pathological diagnosis of PCa in elderly patients,mean age (79 ± 7) years old,which 44 cases were associated with different degrees of LUTS symptoms,of which,20 underwent TURP.After the rule of endocrine therapy,we observe and record of patients before and after treatment and 3,12,6 months after the IPSS and QOL score,compared with the changes in the quality of life of patients.Results Forty-four cases of patients with IPSS score in treatment group after 3,6 and December were (6.25 ± 2.53),(5.15 ± 2.25),(5.00 ± 2.36).Compared with the preoperative IPSS basal value (30.55 ± 3.62),the difference was statistically significant (P ＜0.01).However,there was no significant difference in the postoperative patients (P =0.209,0.863,0.154).The QOL score of treatment group after 3,6 and 12 months were (1.35 ± 1.14),(0.85 ± 0.75) and (0.70 ± 0.87).Compared with the preoperative QOL basal value (4.70 ± 0.73),the difference was statistically significant (P ＜ 0.01).However,there was also no significant difference in the postoperative patients (P =0.078,0.023,0.593).Compared with the control group of IPSS and QOL score,there was no significant difference before treatment in the treatment group (F =0.105,P =0.747),however,there was significant difference after treatment(P ＜ 0.01).Conclusions TURP is a safe and effective method to improve the quality of life and improve the quality of life of patients with prostate cancer.

Objective To study the application of small interfering RNA silencing S100A4 protein in human gastric cancer cell BGC-823 proliferation,apoptosis and the effect of chemotherapy sensitivity.Methods Human gastric carcinoma cell line BGC-823 transfection siRNA,RT-PCR detected the changes of mRNA after transfection.Groups divided into interference group,negative control group and normal control group.MTT test determined different concentrations of oxaliplatin in gastric cancer cells and calculated IC50,then draw cell growth curve,TUNEL method to detect apoptosis,RT-PCR tested each cell mRNA changed,Western blot detected the change of the S100A4 protein.All data analysis by SPSS17.0,t test applied,RT-PCR and Western blot results analysis by SPSS17.0,comparing multiple samples by using single factor analysis of variance and LSD test.P ＜ 0.05 was statistically significant.Results RT-PCR results showed that BGC-823 cell transfection,S100A4mRNA expression quantity respectively after 48 hours:(0.674+0.011),(0.652+0.021),(0.345 + 0.040),the interference group and normal control group were statistically significant (P =0.012,P ＜ 0.05) and the negative control group with interference group differences were statistically significant (P =0.000,P ＜ 0.05),and normal control group was no statistically significant difference with the negative control group (P =0.380,P ＞ 0.380);Western blot results showed BGC-823 cell transfection S100A4 expression significantly lowered respectively after 48 hours,there were (0.654 + 0.025),(0.642 + 0.014),(0.317 ± 0.061),the interference group and normal control group was statistically significant (P =0.01,P ＜ 0.05),between negative control group and interference group were statistically significant (P =0.000,P ＜ 0.05),normal control group and the negative control group had no significant difference (P =0.341,P ＞ 0.341).After S100A4-siRNA transfection,gastric carcinoma BGC-823 cell proliferation decreased,TUNEL method showed obviously increase apoptosis,MTY showed that IC5o of oxaliplatin was 56.31 μmol/L,after transfection,IC50 was 0.654 μmol/L.Conclusions This study showed that the siRNA silence S100A4 protein inhibit gastric cancer cell proliferation,induced apoptosis and improved chemotherapy sensitivity of oxaliplatin.S100A4 might be prompt targets for the treatment of gastric carcinoma.

Objective To study the effects of different type of parathyroid damage to the postoperative functional recovery of parathyroid,through establish an animal model by simulating total thyroidectomy and parathyroid damage during surgical operation.Methods Experimental rabbits for the study were randomly divided into A,B,C,D four groups (n =8),Group A (control group):simple exposure,exploration thyroid and parathyroid;group B (vascular injury group):total thyroidectomy and ligation bilateral parathyroid blood supply but keep the surrounding membrane;Group C (membrane damage group):total thyroidectomy and damage membrane but reservations blood supply.Group D (composite damage group):total thyroidectomy plus membrane and blood both damage;All animals were monitored of serum calcium and PTH,preoperative 1 days and postoperative 1 st day,3rd day,5th day,7t day;cut the parathyroid HE staining to observed survival of parathyroid tissue and pathology damage when 7th day after operation.Results (1) Animals in each group preoperative serum calcium and PTH were no significant difference (P ＞0.05);(2)Group A postoperative serum calcium decreased,but at 5th day returned to preoperative level (P ＞ 0.05);Group B and C postoperative 1st day,3rd day,5th day serum calcium decreased significantly(P ＜ 0.05)and to the lowest at 1 d and then gradually recovered,but group C faster recovered than group B (P ＜ 0.05);Group D postoperative 1 st day,3rd day serum calcium continued to decline significantly (P ＜ 0.05);(3) Group A postoperative serum PTH decreased,but at 7th days returned to preoperative level (P ＞ 0.05).Group B and C postoperative 1st day,3rd day,5th days serum PTH decreased significantly(P ＜0.05)and to the lowest at 1 d and then gradually recovered,but from postoperative 3rd day group C faster recovered than group B(P ＜ 0.05);Group D postoperative 1 st day,3rd day serum PTH continued to decline significantly (P ＜ O.05);(4) Pathology results:Group A parathyroid filled with chief cells and a small amount of vacuolar changes (5％ to 10％);Group B parathyroid hemorrhage,necrosis (40％ to 50％),part of the cell degeneration (30％ to 40％),center with fibrosis,seen granuloma and hyperplasia of parathyroid tissue in surrounding;Group C parathyroid bleeding (10％ to 20％),part of the cell degeneration (10％ to 20％);Group D parathyroid severe necrosis,almost no normal parathyroid tissue,significant fibrosis,less residual parathyroid tissue was scattered.Conclusions (l) The recover of Parathyroid function is influenced by the type of parathyroid in situ injury during thyroidectomy,composite damage of blood supply and membrane of parathyroid is the most serious,parathyroid ischemia necrosis,the function can not be restored,pure blood supply damaged,some can restore function,and the parathyroid gland with vascular pedicle can be recovered quickly.(2) Severe blood supply and membrane damaged,and even free parathyroid should be transplanted immediately during operation.